Infectious Tetanus

Question 1

Disease manifested by skeletal ms spasm and ANS disturbance

Answer 1

Tetanus

Question 2

Tetanus is caused by

Answer 2

Clostridium tetani producing neurotoxin

Question 3

Illness occurs in a child with normal ability to suck and cry in first 2 days of life but loses this ability in 3 and 28 d

Answer 3

Neonatal tetanus

Question 4

Aerobic
G +
Spore forming rod
Highly resistant spore, resist boiling and disinfectant
Spores and bacilli survive in intestinal system

Answer 4

C tetani

Question 5

C tetani toxin

Answer 5

Exotoxin tetanospasmin minimal lethal dose of 2.5 nanogram/kg

Question 6

Tetanus transmission

Answer 6

Superficial abrasion to limb

Deeper infection severe and worse outcome

> 60 poor prognosis

Question 7

Tetanospasmin MOA

Answer 7

retrograde transport in CNS

B toxin closely related in structure and function

Question 8

Most common initial symptom

Answer 8

Trismus lockjaw

ms pain
Stiffness
Back pain
Difficulty of swallowing

Question 9

Most common cause of death in tetanus

Answer 9

Respiratory failure

Question 10

Autonomic disturbance CV, GI, renal failure felt at

Answer 10

2nd week of sx

Question 11

Tetanus dx

Answer 11

clinical findings

culture is supportive

Question 12

Poor prognosis

Answer 12

>70 
Incubation of less than 7d
Short time from first symptom to admission
Period of onset <48
HR >140
SBP >140
Fever
Severe spasm

Question 13

Tetanus tx

Answer 13

Metronidazole 400mg rectally; 500mg IV q6 x 7d

Question 14

Alternative drug

But

Answer 14

Penicillin

Aggravates spasm

Question 15

TIG as antitoxin single IM DOSE

3000-5000 U

Answer 15

In the ER

spasm control with bzd
secure airway
CV instability inc sedation
Recovery 4-6w

Question 16

Guideline for immunization

Answer 16

3 doses in infancy

Booster at 4-7, 12-15 and 1 adulthood (Tdap)

Question 17

For unimmunized pregnant

Answer 17

2 doses at least 4 weeks apart

Question 18

Clinically significant

Responsible for clinical manifestation

Answer 18

Tetanospasmin

Question 19

Tetanospasmin affects the spinal inhibitory neuron

Answer 19

Renshaw cell

Question 20

Neurotransmitters inhibited

Answer 20

GABA

glycine

Question 21

Most common symptom in neonate

Answer 21

Poor suck

Inability to feed

Question 22

Pathognomonic of tetanus sx

Answer 22

Opisthotonus

Risus sardonicus

Question 23

Most common cause of neonatal tetanus

Answer 23

home delivery

obstetric complication - omphalitis

Question 24

Penicillin is a

Answer 24

GABA antagonsist

similar with tetanospasmin